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What is Medicare Homebound Status?

What does it mean to be homebound according to Medicare, and why does it matter in home healthcare?

In order for Medicare to pay for home healthcare visits, certain criteria must be met. A doctor must issue an order indicating that a patient needs help at home for a medical condition. That order must include a determination that the patient is “homebound.”

Lisa Kristosik, chief clinical officer for Visiting Nurse Association of Ohio, said Medicare considers a patient to be homebound when:

Leaving home isn’t recommended because of the patient’s condition.

The patient is unable to leave home without assistance from an individual or device. These devices might include a cane, a walker a wheelchair or ramp.

It takes a “considerable and taxing effort” for the patient to leave home.

A VNA of Ohio nurse’s initial assessment of a new patient includes the “face-to-face encounter” that physicians use to certify that the patient meets these criteria.

Still, Kristosik said there tends to be some confusion among patients and families about homebound status.

What it Means to be Homebound

1. Homebound status does NOT mean that the patient can never leave the house during the period they are receiving home care. Medicare allows for homebound individuals to leave home for medical treatment or short, infrequent non-medical trips, including religious services or special occasions.

2. Homebound status is NOT permanent. In fact, each visit by a home healthcare nurse includes an assessment that evaluates whether a patient’s ability to leave home has changed.

3. The inability to drive is not, in itself, an indicator of homebound status. The question is, does the patient’s medical condition prohibit driving?

“Medicare is very strict about homebound status,” Kristosik states. “But the main question is, ‘What can the patient do safely’?”

Sometimes, through nursing treatment and physical therapy, patients are able to overcome their homebound status. But, Kristosik said, that isn’t necessarily the primary goal of home healthcare.

“Regaining independence is the focus of home care,” she said. “But that doesn’t always mean independence outside of the home.”